Assessment of pathogen reduction strategies in reducing carbapenem-resistant Enterobacterales (CRE) transmission in acute-care hospitals: an agent-based model study

BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) infections are an urgent public health threat in the United States. Despite infection prevention and control measures, hospital CRE rates have not declined in the past decade. Novel drug-based pathogen reduction approaches may decrease CRE incidence, and mathematical models can assess implementation strategies. METHODS: We used agent-based modeling to evaluate a hypothetical drug with pathogen reduction properties for reducing CRE transmission in an example acute-care hospital. We compared a strategy that treated only clinically detected CRE-colonized patients-using three drug effectiveness (DE) levels (25%, 50%, 75%)-with strategies that treated patients identified through surveillance screening in addition to clinical cultures. Surveillance screenings (intensive care unit (ICU) or all-admission screenings) were implemented at 50% and 100% patient participation (PP). Model parameters were informed by administrative healthcare data and published literature. RESULTS: The baseline mean CRE colonization incidence was 27.4 per 10,000 patient-days (interquartile range [IQR]: 11.7-39.9). Compared to baseline, at DE = 25% the reduction in mean colonization incidence was 1.2% (-0.8%-3.2%) for the treatment-only strategy. At DE = 50%, treatment + ICU screening reduced incidence by 9.0% (7.1%-11.0%) at PP = 50% and 13.2% (11.4%-15.1%) at PP = 100%. The reduction reached 38.5% (37.1%-40.0%) for treatment + all-admission screening at DE = 75% and PP = 100%. CONCLUSIONS: This study underscores the potential of novel drugs as pathogen reduction measures to reduce CRE incidence in US hospitals if deployed strategically. Findings highlight the value of developing pathogen reduction strategies for colonized patients to prevent CRE transmission and infections.